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General NPI Number Information
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NPI Number | 1194194209
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Entity Type | Individual
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Provider Name | KASEY TRUNK
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Gender | Female
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Dates
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Enumeration Date | 09/18/2015
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Last Update Date | 01/30/2019
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Provider Practice Location Address
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Address Line | W892 HWY 96
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City | KAUKAUNA
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State | WI
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Zip | 54130
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Country | US
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Telephone | 920-809-8159
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Fax |
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Provider Business Mailing Address
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Address Line | 417 E FLORIDA AVE
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City | APPLETON
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State | WI
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Zip | 54911-1327
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2101-39
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State | WI
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